“There is significant bipartisan ground from which to reset the health care debate. A good place to start would be my own plan, Coverage, Prevention and Reform (CPR) or the bipartisan Wyden-Bennett Healthy Americans Act. Both of these fiscally responsible, market-based plans would go a long way to produce the reform that the American people need. I look forward to working with the President and my colleagues on both sides of the aisle to get this right.”
The problem is that the current Senate bill is a “market-based plan” with basically the exact same design as Gregg's Coverage, Prevention and Reform proposal. For example, how does the CPR expand coverage:
All Americans should have access to affordable, meaningful health care coverage and no American should lose their life-savings or their home because of illness or injury. The centerpiece of this proposal is to give every American access to an affordable, low-premium major medical private-market health insurance plan that insurers will be required to offer in every state-regulated health insurance market. The proposal:
- Defines a cost structure (not a benefit structure) in order to allow for flexible plan design;
- Expressly allows preventive benefits and disease management under the deductible with nominal co-payments for related office visits;
- Does not include an annual or lifetime cap on expenses above the deductible.
ENSURING ACCESS FOR ALL AMERICANS: In order to ensure that every American has quality, affordable coverage, the proposal requires proof of health insurance for every American over age 18 and requires insurers to offer coverage to all applicants, regardless of health status.
TARGETED SUBSIDIES FOR THOSE MOST IN NEED: The proposal includes direct subsidies for low-income individuals for the purchase of a low-premium major medical health insurance plan – subsidies for both the premium and deductible on a sliding scale up to 300% of the Federal Poverty Level (FPL).
MAXIMIZING STATE FLEXIBILITY AND INDIVIDUAL CHOICES: The proposal directs states to create points of entry for low-income families and individuals to enroll in a health insurance plan and access applicable subsidies. Mechanism design and functions of the point of entry (state-based insurance exchange, regulator, etc.) would be left up to the states. States would also be required to offer additional upgrade packages to be purchased on top of the low-premium major medical health insurance plan for those looking for additional benefits.
So, Gregg's plan would use state-based exchanges, and has an individual mandate requiring every American to buy private insurance. The private insurance would be based on actuarial value, required to cover preventive care, and must not have any annual limits of lifetime limits. To help people afford the insurance, there would be a sliding scale of subsidies for people below a set income level, and a new tax deduction/credit for insurance on the individual market.
I fail to see how this is really different from the Senate bill, which requires people to buy effectively low actuarial value catastrophic insurance, that covers preventive care, from private companies on state-based exchanges, and would provide people with a sliding scale of subsidies to help them afford insurance.
How does Gregg pay for this?
CAP TAX EXCLUSION FOR EMPLOYER-SPONSORED HEALTH INSURANCE: The proposal limits the extent to which employer-paid health insurance premiums and health spending from FSAs and HSAs are excluded from taxation. It includes in employees’ taxable income any contribution that employers and employees made for health care costs that together exceeds $11,500 a year for family coverage or $5,000 a year for individual coverage (based on President Bush’s Bi-Partisan Tax Advisory Panel recommendation).
This is basically identical to the excise tax in the Senate bill, which effectively caps the tax deductible status of employer-provided insurance. The main difference is that the cap in the Senate bill is higher than Gregg wants.
Even most of Gregg's ideas on improving prevention are already in the Senate bill in some form. Take for example:
To provide employers with the opportunity to further develop incentive-based wellness programs, the proposal modifies the Health Insurance Portability and Accessibility Act (HIPPA) to allow rewards for wellness programs to exceed 20 % of the cost of employee-only coverage under a group health plan.
This provision and many other prevention provisions were already adopted in the Senate Finance Committee. The new limit set by the bill is 50%. Likewise, the Senate bill and Gregg's proposal would both try to reform the Medicare fee-for-services payment system.
While there are some differences between Gregg's CPR blueprint and the Senate health care bill, they are, for the most part, very similar. Their plans for providing everyone with insurance and their method for paying for the expansion of coverage are effectively identical. I'm sure Obama would be more than happy push for the few changes to make the Senate bill more in line with Gregg's proposal if Gregg would then promise to endorse the bill.
Starting over with health care reform, as Gregg is asking, to create a bill more Republican-friendly in an attempt to get Republican votes would be foolish. The problem is that the Senate bill is already a Republican-friendly “market-based plan.” It was designed by Max Baucus with that express goal in mind. It is already a very anti-progressive bill that does not reflect the traditional Democratic methods for expanding coverage.
Republican opposition to the Senate bill is simply not policy based. It is based on the cold, political calculation that bringing down health care reform would hurt Democrats in the midterm elections and allow Republicans to win more seats. Obama's refusal to acknowledge this reality has resulted in months wasted and incredible damage done to the Democratic party's brand. If Democrats want health care reform, the only way to make that happen is with Democrats.